After Chaotic Week, Path Forward for Senate’s Health Care Bill Unclear

This week featured a flurry of activities around the Senate’s attempt to strike consensus on how to proceed with repealing and replacing the Affordable Care Act. Senate Majority Leader Mitch McConnell had initially hoped to hold a procedural vote to begin debate on the Better Care Reconciliation Act (BCRA) this week but was forced to postpone the vote after failing to secure support from four Republican senators. Due to their slim majority, Republicans cannot afford to lose support from more than two Republican senators.

After failing to establish consensus on the BCRA early this week, Majority Leader McConnell announced his intention to hold a vote for a repeal-only measure, entitled the Obamacare Repeal Reconciliation Act (ORRA), next week. Almost immediately after McConnell’s repeal-only announcement, four Republican senators announced their public opposition to the plan, citing concerns over the drastic impact a full ACA repeal would have on Americans. President Trump convened all Republican senators at the White House for lunch on Wednesday where he urged the senators to reconcile their differences and come to an agreement on health care, even if it required them to stay in Washington into the August Congressional Recess.

Following the Senate Republican gathering at the White House Wednesday afternoon, Majority Leader McConnell indicated he would restart discussions of repealing and replacing the ACA, with a procedural vote to debate the health care measure to be held next Tuesday. However, it is unclear which measure the Senate will be voting on next week. Republicans continue to hold meetings with members of their own party, attempting to strike a consensus on the two leading options – the repeal-only ORRA measure or an updated version of the BCRA. The latest reports suggest that both options lack the necessary votes to even to take up one of the selected measures on the Senate Floor.

The Congressional Budget Office (CBO) released an analysis of the repeal-only ORRA measure on Wednesday, which indicated by 2026, the number of uninsured Americans would increase by 32 million, average premiums would double, and federal deficits would decrease by $473 billion.

On Thursday, the CBO released an analysis of the updated version of the BCRA, which indicated by 2026, the number of uninsured Americans would increase by 22 million, premiums would decrease by 25 percent, and federal deficits would decrease by $420 billion. Notably, the updated version of the BCRA strips the Cruz Amendment, keeps some taxes the initial BCRA repealed, and makes other minor technical modifications.

Further, Senator John McCain announced this week he has been diagnosed with brain cancer and may be limited in his ability to debate or vote on the health care measure next week, which only complicates matters for Majority Leader McConnell as his margin for losing supporting votes likely becomes even slimmer. As the week concludes and a vote early next week nears, it remains unclear how the Senate plans to proceed with their attempt at repealing and replacing the ACA.